Rwanda is first sub-Saharan African country to roll out measles and rubella vaccination

Giovance and her three youngest chlidren, Ukwishaka (8), Hope(6) and Gift (1).

By Suzanne Mary Beukes

NYAKARIRO,Rwanda, March 2013 - After working in the small field near her home in the early morning, 37 year old Giovance Kyomugisha bathes and dresses three of her youngest children Ukwishaka (8), Hope (6) and Gift (1) for the important day ahead. Today, she will take them to the nearby clinic to receive a combined vaccination against measles and rubella.

Unfortunately measles is something she knows all too well. Last year, all five of her children contracted measles following a small outbreak of the disease in her village. She believes it came from a family nearby who refuses to vaccinate their children. “This is a terrible sickness. It is the worst sickness that my children have suffered from. They had a very high fever, diarrhea and a constant cough,” she says, recalling the frightening time. Fortunately she took all the children to the healthcare centre where they were treated and soon recovered.

However, Giovance is confident that the situation could have been a lot worse if her children had not received their first measles vaccination, “It was bad, but I think the symptoms would have been more severe if they had not been vaccinated before.”

Over the last decade, Rwanda has rolled out the measles vaccine throughout the country, reaching over 90 per cent of children. As a result, the country has significantly reduced the number of outbreaks and deaths caused by the contagious disease. In 2012, there were no reported deaths caused by measles. Yet, as cases of measles declined, there was an increase in the reported cases of rubella, otherwise known as German measles, over the last three years. Clinically, Rubella has similar symptoms to measles such as a rash and fever but is generally considered milder. However, if rubella is contracted by a pregnant woman during the first trimester of pregnancy, it may cause a miscarriage or severe birth defects, known as Congenital Rubella Syndrome. It is estimated that some 100 000 children around the world are born with this syndrome each year.

Giovance did not know about Rubella until she heard about it on a radio show in the lead up to a nationwide campaign aimed to vaccinate children under the age of 15 against measles and rubella in one single vaccine. The information provided convinced her that her children should be vaccinated against both diseases.

“It is extremely significant for child survival, that the measles-rubella combined vaccine is introduced in Rwanda today. It will literally save lives,” says UNICEF Rwanda Representative, Noala Skinner. “Those girls who have been vaccinated today – the future mothers - are now also protected. So there is a layer of protection around the children, and around the future children,” she added.

A long-lasting immunisation strategy

Rwanda is the first sub-Saharan African country to introduce the dual measles-rubella vaccine through a nationwide campaign targeting nearly five million children. The campaign was made possible with the support of the GAVI Alliance, WHO, UNICEF and other partners. “GAVI’s approach is very much lead by the countries – so it was Rwanda who asked for this vaccine,” explains Charlie Wetham, spokesperson for GAVI Alliance in Rwanda.

Once the country has applied for support from GAVI, we work closely with them and with UNICEF and WHO who work in the country, to talk to the Ministries about what is most advisable.”

By 2014, the dual vaccine will become part of Rwanda’s routine immunisation programme. Dr. Maurice Gatera, Director of the Expanded Programme on Immunization says, “After this campaign we are going to put the combined measles-rubella campaign into the routine immunization programme so that every child who is 9 months will receive the combined rubella and measles vaccine.”

This move adds to Rwanda’s already stellar performance in saving children’s lives from preventable diseases. Vaccines such as pneumoccal, and rotavirus have immunised Rwanda’s children against pneumonia and diarrhoea -- two of the biggest childhood killers in the country. Combined with efforts to prevent and treat malaria, and community nutrition programmes, child mortality rates have dropped by two-thirds. Rwanda has not only attained the MDG4 on child survival , but is on track to surpass it.

One year old little Gift is comforted by his mother Giovance and two older siblings after he was given a measles-rubella vaccine during a nationwide campaign.

The critical role of community health workers

Vaccines certainly play a crucial part of an overall national healthcare strategy. Yet such strategies are carried out at the local level by some 45,000 community health workers like Belina Dusenge, who lives down the road from Giovance’s family. An elegant woman in traditional dress and headgear, she ensures that families in her village are informed about the importance of the dual measles-rubella vaccine and other vital health services that will protect children from disease. Her role in a nationwide measles-rubella campaign is critical to its success.

“As community healt¬¬h workers, when the vaccination period is about to begin, we document all children who are supposed to be vaccinated and we send that information to the health centre and keep a copy of the records ourselves,” Belina explains. “When the campaign begins, we go to the vaccination sites and crosscheck the information to know who is being vaccinated, and who is not.”

A moment of pain for a chance at a healthy life

It takes just a small moment of the pain from the pick of a syringe needle to set little one-year-old Gift into a frenzy of tears. Giovance nurses him while her two older children, Hope and Ukwishaka, are far more composed during their vaccinations. Once Gift is calm and the tears have subsided, they set off back home with blue vaccination cards which show they have received the measles-rubella vaccine. Giovance now has the peace of mind knowing she has given her children the best defence against these two diseases, and a chance at a healthy life.